Compelling commentary on children's health

When I coined milk protein allergy in babies as “the other colic” (title of chapter 5 in Colic Solved) I never thought it would grace the pages of The Wall Street Journal. Last week’s reflux piece makes an encore in today’s health mailbox.

Here’s my evidence that acid reflux in babies has evolved into its own cottage industry: reflux resistant baby wear. The folks at Do-Over Clothing have come up with a onsie with a removeable/washable snap-on front that’s both water resistant and breathable. This prevents the requisite wrestling match that comes when removing a soggy, vomit saturated piece of cotton from over your baby’s head.

I haven’t decided if this is a brilliant Godsend or just a case of advanced fabric technology desperately looking for an application. Either way, as one who spends his days poking and palpating through regurgitation drenched clothing, I say bring it on.

I ran into owners Michael and Diane Simpson at the recent Baby Faire in Houston. And if the size of the crowd at their booth is any indication of demand, this is one reflux item to watch. I’m planning to test drive the Do-Over with one of my pediatric gastroenterology colleagues at Texas Children’s Hospital who just had a baby boy.

The other day my son asked for plain Greek yogurt with fresh fruit, granola and honey. It turns out he had been hanging out with the South Africans next door when this was on the menu. The kids there eat it, Nick tried it and decided he’d like to take the idea home.

Perhaps it’s his Armenian genes. More likely it’s the influence of peers on diet preference. It shouldn’t be underestimated. Beginning in late toddlerhood, social circumstances begin to influence what children do with food. They begin to eat for reasons beyond their metabolic demand. This can be both a good thing and a bad thing but it can be exploited.

While you may not have South African expats living next door, we’ve all got people in our network who eat better than we do. Find them, introduce your kids and be amazed.

Melinda Beck penned a nice piece on the reflux-colic debate in today’s Wall Street Journal. The article, Baby Crying? Doctors Say It May Be Acid-Reflux Disease, is nicely balanced and catches the clear and present trend that the concept of colic is finally approaching DNR status.

Favorite quote: The suggestion by Dr. Vikram Khoshoo that as a doctor the purpose served by the treatment of acid reflux in a baby is to get mothers off your back (note to self: reassess West Lafayette, Lousiana as a leading center of thought in medicine). And there's lots of good press for Beth Pulsifer-Anderson and PAGER (Pediatric/Adolescent Gastroesophageal Reflux Association) who are always working to legitimize screaming babies.

You’ll find me, the pediatrician desperately pulling up the rear, with the contrarian view that babies who scream deserve real attention. While The Wall Street Journal identifies my daughter Laura as the source of my reflux epiphany, I have to admit that the success of treating thousands of babies misdiagnosed as colic perhaps represents my greatest influence.

I just read Tara Parker Pope’s New York Times piece (Sunday July 13, 2008) on the American Academy of Pediatrics cholesterol position and I’m disappointed. Without so much as a shred of evidence, Ms. Pope suggests a link between the AAP’s recommendations and inappropriate influence by the pharmaceutical industry. As a major manufacturer of vaccines, Merck, for example, has a longstanding history of support for medical education. To imply that such support would in any way influence AAP policy on child health is irresponsible.

Beyond implicating the Academy, Ms. Pope creates more innuendo when she details the history of funding support for individual members of the AAP’s Committee on Nutrition. But the piece is unable to make any connection between support for a visiting professorship five years ago, for example, and a 2008 opinion on cholesterol. But the suggestion of a connection it seems is enough to question the integrity of several esteemed academic pediatricians.

The American Academy of Pediatrics takes conflict of interest very seriously. The suggestion of impropriety in this piece is an insult to an organization that has always put the interest of children above all else. Beyond insult, Ms. Pope and the New York Times have done their part to erode the confidence of the public in AAP policies.

As a long-time fan of Ms. Pope I have always held her as an icon of medical journalism. Beginning with her work with the Wall Street Journal I have compulsively read most everything she ever put into print. For pediatric trainees I have held her writing as an example of how to take complicated medical material and translate it for easy understanding.

But what changed on Sunday with Ms. Pope isn’t clear. All I know is that I never read anything quite like this in the Wall Street Journal.

Dr Gwenn has a post today that covers the issue. She’s had some correspondence with the AAP and her post is worth a look.

Stay tuned for The Baby Borrowers, NBC’s latest reality show due to hit the airwaves this summer. It’s billed as a social experiment that asks five teenage couples to fast-track to adulthood by becoming caring parents to babies, toddlers, and pre-teens. In one episode the teens are charged with the care of a toddler and are required to provide for the child just as a parent would. The teens are video monitored 24/7 by the parents who are positioned in the house next door. Sounds compelling.
But it seems not everyone’s excited. The American Academy of Child & Adolescent Psychiatry has petitioned NBC requesting that The Baby Borrowers be docked. They cite concerns over potential separation anxiety in the child participants. I couldn’t disagree more. In fact, the opportunity to leave my kids with a sitter represents a real therapeutic break for both my children, myself and my wife. Distance makes the heart grow fonder … especially when you live with a strong-willed four-year-old.

While short-term The Baby Borrowers would appear to be a tenuous concept, the market has a way of sorting such issues out. I predict this show will not survive its initial airing. I do plan to check it out, however, and based on the clips released by NBC I suspect I’ll laugh. I could use it.

Regarding the role of physician organizations as watch dogs of the media: they should pick their battles. And this clearly isn’t one worth fighting.

Hold that chicken finger. The American Academy of Pediatrics today issued a fresh policy statement on the management of high cholesterol in children. Bottom line: kids from families with a significant history of heart disease should be screened between the ages 2 and 10 years. Significant elevations in a child’s lipid profile should be managed with diet for 6-12 months and reevaluated. It is recommended that kids over age 8 years with persistent elevation in LDL cholesterol as defined by the AAP’s policy be considered for cholesterol lowering medications.

But before you get that warm, fuzzy feeling that we’ve got it all figured out, here’s what we don’t know:

Does elevated cholesterol in childhood predispose to later heart disease? There are no studies proving this to be the case although we assume what applies to us applies to our kids.

Will the long-term use of cholesterol lowering medications beginning in childhood prevent adult heart disease? We just don’t know.

While the pharmacologic management of the dangerously at-risk child is more clear cut, many kids fall into the fuzzy category. And when it comes to the long-term use of medications for what is a dietary problem in many cases, we approach what could be a very slippery slope for both parents and pediatricians.

We spent the Fourth of July with friends. At sunset a poolside BBQ gave way to fireworks – roman candles, bottle rockets, screamers and the like.

Someone commented that I looked nervous. Couldn’t argue with that. While I grew up with my share of black cats and bottle rockets, I was a little on edge given my line of work. Most of my encounters with children and fireworks involve some type of burn or dismemberment. And watching my nine-year-old ignite the fuse of a roman candle could only give me pause. But upon becoming a father, I swore not to let my biased experiences as a pediatrician influence the normal experiences of my children. This has been a challenge at times.

Could my son have lived without the experience? No doubt. Did he have a ball? Absolutely. The best part: shouting “fire in the hole” while running from the sparkling fuse.

I don’t see this every day: a major publication devoting significant space to tell parents precisely why children need vaccinations. Reference Parents Magazine and their July 2008 feature, Why Babies Need Shots. Their interview with Dr. Ari Brown also offers real answers to real questions. Refreshing really when you consider how often the main stream media supports the loud voice of a misinformed anti-vaccine minority peddling fear and conspiracy theories.

Hats off to Parents Magazine for using their valuable platform to help advocate for children.

It’s a worn out debate with real staying power: Is it harder to raise boys or girls? Paula Spencer at CNN.com resurrects this timeless parental debate and suggests that boys may be tougher than girls.

I was contacted by Houston’s KTRH news radio for a comment this morning and my view was painfully simple: there is no answer. For every parent who gushes about the ease and self-sufficiency of their daughter there’s another who curses their daughter’s high maintenance. The same can be said for boys. While gender may temper things, difficulty is ultimately child-driven and dependent on temperament and personality. The association of difficulty with a particular sex is a random event and seems to go both ways. And the role of parental disposition shouldn’t be overlooked. We’re half of the relationship that we share with our kids.

While we can’t deny the obvious differences between the sexes, their contribution to issues of rearing difficulty is overdone.